The problems of developing and maintaining stable health care resources and systems in underserved rural areas are well known and have become a critical issue in the debate over health care reform. The Maine/AHCPR Rural Center (Rural Center), a consortium of health sciences and state health policy organizations, will assist two rural, underserved regions in Maine develop strategies for responding to changing local conditions and broader state and federal health reform initiatives. The project will link community and provider stimulated initiatives already underway in these rural areas with research and practice findings regarding successful models of rural health care delivery, network development, and managed care. The project will focus on the following key elements of a sustainable rural health care delivery system of the future: (1) the establishment of a vertically integrated network approach to health care delivery, based on the collaborative affiliation of providers, the business community and consumers, (2) the application of managed care principles to service delivery, including case management, risk-based contracting, practice guidelines and tools for monitoring and improving the quality of care, (3) the development and provision of provider and consumer educational programs to strengthen their respective roles and relationships in a managed care environment, (4) the design and implementation of information systems to provide accessible data for analyzing network performance and supporting its managed care activities, and (5) the dissemination of reports and information to advance local, state and national understanding of the issues and challenges of creating integrated managed care delivery networks in rural areas. The Rural Center will strengthen the capacity of local leaders and procure additional resources and expertise to fully design and implement a vertically integrated network approach for the delivery of managed health care services to rural populations. Specific support of the Rural Center will include financial/actuarial assistance in the design and implementation of payment arrangements; tools and methods for implementing a comprehensive quality assurance system; and the development of information systems to support network operations. The Rural Center will also link the demonstration sites to other AHCPR sites and Centers and will serve as a resource for rural health policy development.